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Published on: February 19, 2021
Implementation and modification of an organizational-level intervention: a prospective analysis
Elisa J Gordon1, Jefferson J Uriarte2, Naomi Anderson3
1Department of Surgery - Division of Transplantation, Center for Health Services and Outcomes Research, Center for Bioethics and Medical Humanities, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair, 20th Floor, Chicago, IL, 60611, USA. e-gordon@northwestern.edu.
Modifications during intervention implementation were explained by pre-existing factors identified during preparation. Understanding these factors can improve intervention fidelity and outcomes in healthcare settings.
Area of Science:
- Implementation Science
- Health Disparities Research
- Transplant Program Management
Background:
- Intervention modifications can negatively impact outcomes.
- Pre-implementation barriers and facilitators may predict modifications.
- This study examines modifications in a complex organizational intervention.
Purpose of the Study:
- To describe modifications made to a culturally competent intervention.
- To examine how implementation science factors influenced these modifications.
- To understand how pre-existing factors explain intervention changes.
Main Methods:
- A comparative case study of two kidney transplant programs.
- Qualitative interviews with 57 transplant stakeholders.
- Analysis guided by the Consolidated Framework for Implementation Research (CFIR) and FRAME.
Main Results:
- Site-B made more modifications (n=29) than Site-A (n=18).
- Modification types varied, with delaying/skipping and adding being site-specific.
- Transplant teams initiated most modifications; CFIR inner setting factors explained differences.
Conclusions:
- Organizations implementing interventions make modifications.
- CFIR inner setting factors identified during preparation explained modification patterns.
- Addressing pre-implementation factors can improve fidelity and outcomes.
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